Provider Demographics
NPI:1700972387
Name:HARRIS, PHYLLIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 TURK HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564
Mailing Address - Country:US
Mailing Address - Phone:585-425-2820
Mailing Address - Fax:
Practice Address - Street 1:2250 TURK HILL ROAD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564
Practice Address - Country:US
Practice Address - Phone:585-425-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine